Medicaid could save state millions on inmate health, study says

CHARLESTON, W.Va. -- With Medicaid expanding to cover those who make up to about $15,000 a year, West Virginia could save millions of dollars over the next few years by using Medicaid funds for treating eligible inmates, a health policy analyst said.

Brandon Merritt, of the West Virginia Center on Budget and Policy, estimates the state can save $20 million between 2014 and 2020 by using Medicaid to cover eligible inmates.

That projection is based on figures from the state Division of Corrections and the Regional Jail Authority, he said.

"It's one of those unheralded components of the [Affordable Care Act] that's really beneficial, and states that have chosen not to expand Medicaid are not going to see these savings," Merritt said. "We really feel that people need to be aware that there are so many aspects of the ACA that benefit our state and our state's bottom line."

Inmates are not eligible for Medicaid coverage while incarcerated because they're provided with medical care. This does not change under the Affordable Care Act.

An exception to that rule is that if the inmate has been treated in a facility outside the jail or prison for 24 hours or longer.

Currently, Medicaid provides health care to certain groups of people including children and pregnant women, as well as those with disabilities. Very few inmates are eligible currently, said Debbie Hissom, director of inmate health services for the Division of Corrections.

That changes in 2014 under the Affordable Care Act, when the state's Medicaid program will cover those who make up to 133 percent of the federal poverty line.

Under those guidelines, only a rare inmate who draws a pension or other retirement funds might be ineligible, Hissom said.

Under expansion, the federal government will foot 100 percent of the Medicaid costs for the first three years. After that, the federal match gradually will decline to 90 percent.

Hissom said the Division of Corrections, for its part, could save more than $1 million a year on inmate health care by using Medicaid for inmates who are eligible and who are being treated in hospitals for longer than a day.

State officials have not yet formed a plan for determining the Medicaid eligibility of the inmates, said Lawrence Messina, a spokesman for the West Virginia Department of Military Affairs and Public Safety.

One way would be to determine the eligibility of all the inmates -- nearly 7,000 people in prison and jails. Another way is to wait until the inmate has been in a hospital for at least a day and then determine if the inmate is eligible for Medicaid based on their income.

Medicaid has a three-month "look-back," which means when a person signs up for the program, Medicaid can cover the last three months of their medical bills.

The state has 5,585 inmates in 16 state facilities, two of which are work release facilities. Another 1,200 people are inmates of regional jails.

The state Division of Corrections currently contracts with Pittsburgh-based Wexford Health for the care of inmates in state prisons. The state pays an average of $23 million a year on inmate health. Under the contract, Wexford Health pays the first $5,000 for an inmate's care and the Division of Corrections picks up the tab for anything more than that.

The cost of treating inmates has been rising because of an increase in the number of inmates with chronic illnesses, an aging inmate population and because of the overall rising costs of health care, Hissom said.

Officials haven't yet decided on the logistics for signing up the inmates, she said.

Messina said the state hopes to have a plan in place by January. Reach Lori Kersey at lori.kersey@wvgazette.com or 304-348-1240.